Tech Lectures. For the Pharmacy Technician. P.O. Box Denver, CO Lecture 20 Assisting the Pharmacist

Transcription

1 1 Tech Lectures For the Pharmacy Technician P.O. Box Denver, CO Lecture 20 Assisting the Pharmacist It is respectfully requested by the Author that no part of this Tech Lecture be reproduced or transmitted in any form, by any means without express written consent. Joe Medina CPhT, B.S Pharmacy Tech Lectures Copyright 2015

2 2 Assisting the Pharmacist Retail Setting The role of the Pharmacy Technician continues to evolve as the job description for the Pharmacy Technician continues to be defined. The dispensing function, once the domain of the Pharmacist, now has become the primary function of the Pharmacy Technician allowing the Pharmacist to engage in the counseling of patients and monitoring drug therapy. Roles of the Pharmacy Technician include: 1. Receive prescription or medication order Ensure the prescription or medication order is complete and accurate 2. Receive refill requests from patients over the phone Ensure refill is available or if not a physician is called to authorize refill(s) 3. Input prescription or medication order into the computer Ensure entry of data is correct and corresponds to the prescription order 4. Retrieve, count, pour, weigh, measure and mix medications Ensure correct medication, strength and quantity 5. Compound and/or reconstitute medications Ensure all measurements are accurate and recipe is followed accurately 6. Select type of prescription container Ensure proper size container for amount dispensed 7. Affix prescription label and auxiliary label(s) on containers Ensure auxiliary labels are correct for given medication given 8. Price prescriptions Ensure price is correct including any insurance or copay discounts

3 3 9. File prescription hard copies Ensure prescriptions are completed properly and filed correctly 10. Establish and Maintain Patient Profiles Ensure up to date information in computer profiles 11. Inventory Management Ensure stock inventory is not over or under need of the pharmacy setting 12. Other Ensure you are meeting both Pharmacist and customer needs. In assisting the Pharmacist the Pharmacy Technician should be familiar with basic concepts involved and realize that any task requiring a judgmental decision is to be directed to the Pharmacist. 1. Receive prescription or medication order A prescription order is a lawful order for a specific medication to be given in a specific dose and for a specific period of time. This order is generally written by a licensed Physician but, depending on individual state laws and prescribing restrictions, can also be written by Dentists (DDS, DMD), Podiatrists (DPM), Optometrists (OD), Veterinarians (DVM), Physician Assistants (PA), and in some states, Pharmacists (RPh). Prescription orders can be delivered either in person, by mechanical means such as a fax machine, computer data transmission or by phone order. All handed in or faxed prescription orders must have the physician s signature. If the physician is unable to call in a prescription order himself or herself, a representative of the physician such as a nurse may call in the prescription order. In most states the Pharmacist is the only one who can receive new phoned in prescription orders. The role of the Pharmacy Technician in accepting prescription orders by a customer or a representative of that customer begins with understanding the proper procedures involved. Procedures are generally stated in the Pharmacy Procedures Manual and should be reviewed in the beginning of one s employment in a particular Pharmacy setting.

4 4 Parts of a written Prescription order Every prescription order received should contain the following information: 1. Prescriber s name, address, phone number Ensure information is correct and up to date 2. Name of Patient for which the prescription is written for Ensure the prescription corresponds to the patient needing the medication 3. Date the prescription written Ensure the date is within guidelines for the filling of this prescription 4. The medication ordered including name, strength, dosage form and quantity Ensure correct medication, strength, dose and quantity 5. Directions for use Ensure directions corresponds to this particular medication 6. Number of refills permitted Ensure refills correspond to this particular medication 7. Whether substitution of generic drug is permitted Ensure generic drug is okay to use, if not dispense as written (DAW) 8. Prescriber s Drug Enforcement Number (DEA) if this is a controlled medication order Ensure DEA number matches prescribing physician 9. Physicians signature Ensure physicians signature corresponds to the prescribing physician

5 5 Prescription validity One role of the Pharmacy Technician is to ensure a prescription is valid. In another words not a forgery or illegal prescription is being processed. In the retail setting this problem does arise on occasion and with advanced technology is often times difficult to find. Forgeries can be as simple as changes being made on a regular prescription order such as increased quantity needed to outright stolen prescription blanks being filled out. Irregardless, many of these prescriptions are legitimate-looking and thus scrutiny is necessary in the filling of all prescription orders. This is especially true for controlled prescriptions orders in which most forgeries occur. One way to help prevent this is the need for a Drug Enforcement Agency (DEA) number on each controlled prescription ordered. Correct DEA Number? The first letter will either be an A or a B which is indicative of when the DEA number was given. The second letter will always be the first letter of the Physician s last name. A mathematical calculation exists which ensures that the DEA number is correct: Add the first, third and fifth numbers to get your first answer Add the second, fourth and sixth number then multiply your total by two to get your second answer Add your first answer with your second answer. The last digit of this sum will be the same as the last digit of the DEA Number. Example: AH ) = 9 2) = 12 x 2 = 24 3) = AH

6 6 Interpretation of a Prescription Order The understanding of the interpretation of a written prescription order is essential. This allows the Pharmacy Technician to input necessary information in the computer with the correct information needed. Upon receipt of a prescription order, the Pharmacy Technician should be able to interpret the prescription fully and notice any missing information that may be necessary to properly fill the prescription order. The Pharmacy Technician can complete some missing information, but the Pharmacist must do missing information that requires professional judgment. Example completed prescription: Dr. Lawrence A. Smith M.D. 366 Holly Lane, Denver, CO (303) Patient Joe Medina Date September 20, 2015 Address 7030 Estrella Avenue Rx Zoloft 100mg #60 Sig: i po qd x 60 days for depression D Lawrence DAW: Refills 6 DEA REG. No.

7 7 Directions In most cases the directions (Sig: to give) is written in short-hand notation or abbreviated form that allows directions to be easily written and more precise. Directions generally include how to and when to take the medication ordered. Direction Parts Example: Take 1 tablet by mouth once a day for sixty days for depression 1. How to administer this medication Ensures the correct way this medication is to be taken whether Example: Take 2. dosage form Ensures the correct dosage form is being given Example: 1 tablet 3. route of administration Ensures medication is being administered correctly Example: by mouth 4. frequency of dose Ensures dose is given at the correct time Example: daily 5. length of time of dose Ensures completion of medication Example: for sixty days 6. reason for medication given Ensures patient is reminded of why they are taking this medication Example: for depression

8 8 The Pharmacy Technician should have knowledge of abbreviations associated in the interpretation of prescription orders. This is the only way a Pharmacy Technician will be able to correctly input directions into the computer and ensure the correct directions will be on the Pharmacy label when the medication is dispensed. From the list of abbreviations we are able to create sentences to create directions. Example: ii gtts OU qid ud translation: Instill 2 drops into each eye four times a day as directed Misinterpretation of Directions Due to human qualities, misinterpretation of prescriptions does occur. This is especially true in the name of medication and prescribing directions. An understanding of abbreviations is vital as well as the interpretation of these directions in an easy to understand format for the patient to completely understand how they are required to take this medication. Example: 1 po tid x 10 days okay transcription: Take one tablet orally three times a day for ten days better transcription: Take one tablet by mouth three times a day for ten days Example: 1 pr qd prn okay transcription: Insert 1 rectally daily as needed better transcription: Remove foil and insert 1 suppository in rectum once a day as needed The correct filling of a prescription order does depend on the Pharmacy Technician s correct interpretation of a written prescription order. Although the Pharmacist does a final check, all attempts to ensure correctness by the Pharmacy Technician is vital. In some cases the prescription directions may be difficult to interpret due to the handwriting of some prescribers. If any question of the validity in the directions or any part of a prescription order is necessary, the Pharmacist should be notified. In this case the Pharmacist will make necessary changes or call the prescribing physician for clarification.

9 9 Some common misinterpretations The abbreviation u for unit should never be used as it could be misinterpreted as 0 and cause a ten-fold dosing error. Decimal points after a whole number should never be used as 25.0 could be misinterpreted as 250. Decimal points should be used for numbers less than zero is much easier to interpret than a.25 dose. Medications on Prescription Orders The medication being written for is as vital as the directions for the medications use. The correct interpretation of medication being ordered including strength and quantity is important. Misinterpretation does occur with thousands of drugs being written for, poor physician handwriting and drugs that phonetically sound the same. An understanding of Trade and Generic names is necessary to correctly interpret a prescription order. Prescription Transfer In most states only a Pharmacist can accept a transferred prescription from one pharmacy setting to another pharmacy setting. State laws differ as to whether the original prescription is cancelled when a transfer is made. A new prescription is required to be transcribed on a new prescription form (hard copy) by the Pharmacist receiving the transfer with regular essential information as well as transfer information. Some pharmacies such as Walgreen s have the database of all prescriptions filled by Walgreen s within the United States that makes the transfer of prescriptions within this organization unnecessary. 2. Receive refill requests from patients over the phone Refill requests by the patient or prescribing physician s office can be taken by the Pharmacy Technician. When taking refill requests ensure you are refilling the correct prescription order. It is advisable to repeat vocally the number of refills authorized to the one giving you the information to ensure transcription of information is correct. The taking of new verbal prescription orders by phone has long been the domain of the Pharmacist. Because Federal law does not discuss this issue, some states are allowing this function to be done by Pharmacy Technicians under the guidance of a Pharmacist.

10 10 3. Input prescription or medication order into the computer In the Pharmacy setting computers are used to input or enter information that will provide a patient record or profile, prescription label, basic medication information sheet for the patient and insurance information. The inputting of prescription orders into the computer system is the first step in creating a computer hard copy. Each pharmacy is required to complete one computer backup a day to ensure records are up to date. The first step in inputting or entering information derived from the prescription is to ensure the patient has a patient record or profile with necessary information which not only includes information from the prescription such as patients name, address and telephone number but also other pertinent information. Many computers now days have a user friendly fill in the blank format in which to enter necessary information. If the format is not user friendly, repeated use will make a Pharmacy Technician efficient in the entering of data. Steps (blanks to fill in) involved in inputting a prescription order: 1. Fill in patient s name if patient is already in computer system or if patient is a new patient, create a profile for patient 2. Fill in the physician s name ensuring this is the correct prescribing physician 3. Fill in medication needed. Ensure this is the correct drug as to be given as written on the prescription order. Most computers have a list of generic alternatives if it is okay to give a generic. Once a decision of which drug to use is made, inputting of information can be done by drug name or the National Drug Code (NDC) number which ensures correct medication. Any question on correct medication to give should be directed to the Pharmacist. 4. Fill in the directions as indicated on the written prescription. Most computers have short codes to enter to achieve a full sentence direction. If you are not sure of the proper code to use, just fill in the blank with long-hand directions to ensure the individual gets the correct information. A properly trained Pharmacy Technician may notice directions that do not match the medication prescribed. Any questions concerning the directions should be directed to the Pharmacist. 5. Fill in other blanks that may be required or not already filled in automatically again ensuring that information is the exact copy of information from the written prescription order.

11 11 Once all blanks are completely filled in the computer will do a final check to ensure all information is correct and to also alert the Pharmacist of any potential problems that will include: Potential allergic type reactions Drug-Drug interactions Refill status such as too early to refill Potential harm to fetus if patient is pregnant Dosing discrepancies such as too high or too low of a dose Should an alert arise from the computer, the Pharmacy Technician is directed to the Pharmacist who will look at the potential problem and either accept the prescription or make necessary changes. After a Pharmacist s check that requires the Pharmacist to enter a code, the computer will process the information and update its database and create labels and other useful printouts such as payment receipts or basic patient medication information sheet. The prescription label Finished prescription labels derived from the computer should contain the following information: 1. Pharmacy name, address and telephone number 2. Prescription or serial number 3. Patient s name 4. Dispensing date 5. Medication name, strength, dosage form and quantity 6. Directions for use 7. Prescriber s name 8. Expiration date 9. Refills allowed 10. Necessary auxiliary labels including: Rx Only Sample Prescription label Jones Rx 1524 South Windet Denver, CO Rx Joe Medina 9/21/2015 jm Dr. Lawrence A. Smith Take 1 tablet by mouth twice a day for depression Zoloft 100mg #60 Refills left: 4 Rx exp: 9/21/2016

12 12 Some states differ as to whether both the trade name and generic name must appear on the prescription label as well as expiration date and refills. For Federal purposes all of the above prescription label information should be included. 4. Retrieve, count, pour, weigh, measure and mix medications Several years ago the actual filling of prescriptions was the domain of the Pharmacist, but new roles now find Pharmacy Technicians involved in the actual dispensing functions of locating the correct medication and filling the prescription order(s). The filling of a prescription order requires several checks to ensure that the prescription order is being filled correctly. The first check would be when the medication is pulled from the shelf. A Pharmacy Technician should have the original prescription and label in verifying the correct medication, dosage form and strength is being pulled from the shelf. The first check would be to verity upon pulling the medication from the shelf. Once the medication has been pulled, the Pharmacy Technician needs to do a second check before counting the medication or filling the prescription order again to ensure the correct medication, dosage form and quantity to be counted or poured. The third check would be after the label is attached to the container or prescription bottle. This is the final check to ensure accuracy that the correct medication, dosage form and quantity was correctly filled. This may seem overdrawn, but safety issues dictate that the Pharmacy Technician check at least three times before the Pharmacists final check. With practice this actually should become routine in the filling of a prescription order. The counting of tablets or capsules involves the use of a spatula and counting tray. Pharmacy Technicians as well as Pharmacists should avoid touching medication by hand due to the potential for contamination. Therefore all manipulations required in the counting of medications should never involve touching them with your hands. The pouring of medication should also be done without touching the liquid involved. Notes:

13 13 5. Compound and/or reconstitute medications In some cases, Pharmacy Technicians may be asked to either reconstitute or compound a prescription order. In reconstitution the Pharmacy Technician is filling a powdered container with a specific amount of liquid (usually deionized or distilled water) to a specific volume. The need for reconstitution is for medications that have a short expiration date once liquid or diluent is added to its powder volume. Reconstitution can be done in the retail setting, such as the reconstitution of antibiotics (example: Amoxicillin), or in the hospital setting for powdered vials. In compounding or extemporaneous compounding the Pharmacy Technician follows a recipe to make a product such as a solution, suspension, ointment, cream, etc. This type of compounding is under the guidance of a Pharmacist and generally is only done if the Pharmacist feels the Pharmacy Technician to be capable. Compounding Today we find most of our compounded type of medications already pre-manufactured by drug companies. In some cases, whether due to change in dosing or need to change a formulation, the Pharmacy will compound it own prescription orders due to the unavailability from the drug company. In this case recipes are created to help both the Pharmacist and Pharmacy Technician to fill this prescription order. The recipe should be followed exactly and should not be thought of as a cooking recipe where a dash of this and a dash of that is suffice. In compounding exactness is not only necessary but vital to ensure the prescription order is filled correctly. In compounding specific guidelines has been established by the United States Pharmacopoeia or USP. These guidelines ensure safety practice is being followed in the preparation of compounded medication orders. Notes:

14 14 Nine essential guidelines established by the USP include: 1. Organization and personal are responsible to ensure the entire process of compounding yields a product of acceptable and desirable quality. 2. The facility should be maintained to ensure completeness of a compounded product in reducing the chance for alteration or contamination. 3. Equipment should be working properly and maintained per manufacture standards or protocol within the pharmacy setting 4. Control of components and drug product containers of which they should be stored to prevent or minimize the chance for contamination from outside elements 5. Production and process codes should be created for each compounding procedure. This can be in the form of recipes to ensure exactness in identity, strength, quality and purity is established. 6. Packaging and labeling requirements are established to ensure proper containers and labeling is ensured for each compounding product prepared. 7. Holding and distribution of compounded products should be in an area of safety with outside environmental factors held in check such as temperature, humidity and light. 8. Laboratory controls is essential in a lab setting but most pharmacies do not have a lab setting due to limited compounding practice and also compounded medications are generally made for immediate use or dispensing. 9. Record keeping is important in the form of a logbook to establish compounded products made. Each entry should indicate the name of the compounded product made, when it was made, who made it and expiration date.

15 15 6. Select type of prescription container Whether filling a prescription order for tablets, capsules or liquid, the container to use would be the one that will be the closest in size to fill the quantity needed. Never use a vial or bottle that is too big for the volume needed. Vials: measured in drams. The lower the dram number the smaller the size container Bottles: measured in ounces. The lower the ounce number the smaller the size container 7. Affix prescription label and auxiliary label(s) on containers Auxiliary labels provide additional general information such as take with food or milk and other supplemental instructions. Rx Only label replaces the old Federal Law prohibits dispensing without a prescription label - FDA modernization Act Take with food or milk Avoid sunlight Rx Only May cause Drowsiness 8. Price Prescriptions With proper information entered in the computer in the patient s profile, the computer should do the correct pricing for medication received. With most individuals having third party insurance, the computer does calculate the correct third-party payment or money owed. Sometimes information has to be reentered in the case of insurance changes, or addition of a family member to an insurance policy.

16 16 Third-Party insurance includes: Fee-For-Service: this type of insurance plan allows the pharmacy to bill the insurance company when service is rendered. Capitation: this type of insurance allows the pharmacy to have a set amount of money for a membership group regardless of amount of services rendered Most HMO s use this type of insurance plan. Co-Payments: this type of insurance requires the patient to pay a co-pay or partial payment for services rendered. A flat rate is one specific co-pay while percentage co-pay is based on paying the percentage of the total price of drug or service rendered. Spend-Downs: this type of insurance requires the patient pay the full cost up to a specified amount of dollars on prescriptions. Third-part payment does not kick in until this expense is met. Indemnity or out-of-pocket expense: this type of insurance requires the patient to pay the full price of the prescription or service rendered then the patient seeks reimbursement from the insurance company. Generally patients will need a receipt to present to the insurance company for reimbursement. Most patients will have a valid third-party insurance card that must be shown at time of receipt of prescription order for eligibility purposes. Although information may be already in the patient s profile, plans do change constantly and having the card in your hands may make these changes easier as far as data inputting into the computer. Third- Party insurance plans do have limitations in drugs accepted or what is known as formulary restrictions, refills allowed, etc. Formulary: Third-Party insurances generally have a list of drugs they will accept in their program and drugs that they will not accept. This is done mainly for cost restraints in which a less expensive drug that is within the same classification may have the same therapeutic effect as a much more expensive drug within the same classification of drugs. Formularies also may exclude items some individual brand name drugs over their generic counterparts or items that may not be considered as prescription such as cosmetics or weight control products. Insurance billing is one of the most difficult aspects in working in the retail pharmacy setting and requires a great deal of practice or experience. Although the computer is programmed in most cases to handle insurance billing or electronic claims, almost inevitably problems do occur. In rare cases, insurance billing is done by hand. In this case a great deal of practice will help one become efficient.

17 17 9. File prescription hard copies The filing of the original written prescriptions is important to ensure that if it is needed in the future for reference purposes, the prescription can be easily found. Filings of prescriptions are done by prescription number or serial number. Other than Schedule II (Controlled) drugs being filed separately all other drugs including Schedules III to V (also controlled drugs) may be dispensed with regular legend prescriptions but must have a red C stamped on them. Depending on state laws, the Pharmacy will keep these files for a period of five to seven years. 10. Establish and maintain patient profiles Upon receipt of a new prescription order from a new patient, it is up to the Pharmacy Technician to ensure that profile information for that specific patient is entered into the computer system. Profile information would include the following: Patient s Name Patient s Address and phone number Date of birth Allergies Health conditions such as disease states Other medications patient may be taking Insurance plan Other useful information Information must be exact as possible as this is vital in the proper filling of a prescription order and in insurance billing. Mis-information will cause not only cause insurance problems but also potential therapeutic problems in the misfiling of a prescription order. Once information is inputted correctly, simple updates are easy to do when necessary. 11. Inventory Management Stock or inventory levels is important in the Pharmacy setting not only to ensure medication is available in the dispensing of prescription orders, but also to ensure that money is not being wasted with excess or unneeded stock or drugs. In most cases each medication should have an established par level in which the amount of drug has an established turnover rate and there is never too much or too little of this drug available. One aspect in Inventory Management is Pharmacy Technicians who actually work as stock clerks or management assistants. This job function allows them to order medications from either wholesalers or drug companies direct. It allows them to keep inventory control in ensuring drugs needed are there and drugs not needed are returned to the wholesaler or drug company.

18 18 Costs of drugs vary as far as amount ordered. For fast moving drugs it is safe to order large quantities of drugs in batches of 500 or 1000 tablets or capsules as there is a significant cost savings and the drug will be dispensed in a timely manner. For low moving drugs it is best to order small quantities, as you do not want to have an overabundance of slow moving drugs. Ordering is generally through a wholesaler or middleman who generally carries almost anything you need. In special situations, ordering from the drug company may be wise as oftentimes there are discount rates or specials offered. Ordering of drugs can be done either by phone or can also be done by computer. Generally the ordering of drugs is on a daily basis in anticipation of the next 24 hours of drug needs. In some cases pharmacies will borrow or buy drugs from different pharmacies if the need for the drug is rushed. Good relationships with other pharmacies ensure drugs will be available to the patient when needed. The receiving of drugs is also part of the Pharmacy Technician duties. In receiving drugs the Pharmacy Technician must match what drugs have come in with the invoice. Proper counting of incoming drugs is important as mistakes do happen from time to time with the wholesaler. Also the invoice allows the Pharmacy Technician to decide where to order the drug if it is not currently available. All invoices should be signed and dated and indicate what items and quantity of items where delivered. The stocking of drugs ordered should be done in a timely fashion. Older drugs should be pulled up front of the shelf and newer drugs should be placed behind them. Expired drugs should be sent back to either the wholesaler or drug manufacturer depending on what the policy of the pharmacy setting dictates. Different manufacturers have different criteria as far as the return policy of expired medications. Pharmacy Stock Clerks or Inventory Management Assistants play a vital part in the retail and hospital pharmacy setting in ensuring drugs are available when needed and not too much drug is being ordered. A good Pharmacy Technician will save the pharmacy setting much money and headache if the job is done correctly. 12. Other Other job duties of the retail Pharmacy Technician involves sales transactions or the selling of prescriptions and over-the-counter (OTC) drugs. Non prescription drugs or OTC drugs are oftentimes difficult for customers to find and one duty would be to help them locate the product they are looking for. To help customers in need a working knowledge of where OTC items are located is a must. Generally postings are present to help both the customer and Pharmacy Technicians find the product desired. Should the customer require more than just a location but counseling advice, the Pharmacy Technician should direct that patient to the Pharmacist.

19 19 Hospital Setting In the hospital setting the Pharmacy Technician functions differ as prescription orders are now considered to be medication order or Doctor s order which involves a multiple order of many drugs the individual patient who will be taking in the hospital setting. Due to this, medication orders are inputted in the computer only by the Pharmacist to ensure correctness in medication ordered, dosage form, strength, quantity and more importantly clinical problems that may be associated with multiple dosing. The Pharmacy Technician duties differ as he/se is longer involved in customer contact but whether in preparing medication orders and IV Admixtures. In the filling of medication orders Pharmacy Technicians prepare 24 hour supply of individual cassette drawers for patient admitted. Each cassette will have unit-dose or individual prepackaged units of medication and in some cases injectable drugs. Once cassettes are filled they are checked by the Pharmacist to ensure correct medication and doses. In some hospital settings cassettes are check by other Techs. Another different aspect in the hospital setting is the making of IV Admixtures. Pharmacy Technicians today will make 95% of all IV admixture orders required. In doing so the Pharmacy Technician must be trained to understand the concept of aseptic technique and also a basic understanding of calculations and equipment used. Conclusion The roles of the Pharmacy Technician are changing dramatically whereas Technicians are doing much more than years past. In keeping up with these roles it is important that the Pharmacy Technician realize their limitations and never do functions that require a judgmental decision as these roles should be left up to the Pharmacist. About the Author Joe Medina, CPhT, BS Pharmacy, former Program Director of a Pharmacy Technician Program at two community colleges in Colorado is a lifetime national advocate for the Pharmacy Technician Profession. Mr. Medina has helped produce several textbooks and co-authored the Pharmacy Technician Workbook & Certification Review through Morton Publishing. With fifteen years as a Pharmacy Technician and fifteen years as a Pharmacist, Mr. Medina understands the needs of the Pharmacy Technician and the important role they play in interacting with Pharmacists, Medical paraprofessionals and the community in the Pharmacy setting.

20 20 Lecture 20 - Assisting the Pharmacist Multiple Choice (choose the most correct answer) 1. Of the following statements, which one is false? a. A prescription order is a lawful order for a specific medication b. One role of the Pharmacy Technician is to ensure a prescription is valid c. An understanding of trade and generic names is necessary to correctly interpret a prescription order d. A Pharmacy Technician may make judgmental decisions 2. Which of the following professions cannot legally write a prescription order? a. DDS b. DPM c. DAV d. DVM 3. The insurance formulary may a. list drugs accepted in an insurance program b. may exclude brand names over their generic counterparts c. limit what can be used as a prescription items d. all of the above 4. The DEA Number of the prescribing physician is required of all controlled written prescription orders. Of the following DEA numbers, which one is correct? Prescribing Physician: Dr. Margaret Hingle a. AD b AD c. AH d AH

21 21 5.Patient Profile information would include which of the following: a. Patient s Name b. Date of birth c. Allergies d. All of the above 6. Of the following statements, which one is false? a. The medication being written for is as vital as the directions for the medication use b. Many computers now days have a user friendly fill in the blank format in which to enter necessary information c. Should an alert arise from the computer, the Pharmacy Technician may bypass this by entering a code d. The filling of a prescription order requires several checks to ensure that the prescription order is being filled correctly 7. The FDA Modernization Act of 1997 a. Replaced the old Federal Law prohibits dispensing without a prescription label with Rx Only label. b. Necessitated the need for Pharmacy Technicians in the Pharmacy setting c. Replaced the Harrison Narcotic Act of 1915 d. Encouraged the use of automation whenever appropriate 8. Most HMO s use this type of Insurance Plan a. Fee-For-Service b. Capitation c. Co-Payments d. Spend-Downs 9. Procedures in a pharmacy setting are generally found in the following manual? a. Facts and Comparisons b. Pharmacy Procedures Manual c. Material Safety Data Sheets (MSDS) d. None of the above

22 Indemnity or out-of-pocket expense requires the patient to pay the full price of the prescription or service rendered then the patient seeks reimbursement from the insurance company. Generally patients will need a receipt to present to the insurance company for reimbursement a. True b. False 11. Of the following statements which one is false? a. All handed in or faxed prescriptions orders must have the physicians signature b. Refill requests by the patient or prescribing physician s office may be taken by the Pharmacy Technician c. Some states are allowing new verbal prescription orders to be taken by a Pharmacy Technician d. Each Pharmacy is required to complete one computer backup once a week 12. In some cases the prescription directions may be difficult to interpret due to the handwriting of some prescriber s. If any question of the validity in the directions or any part of a prescription order is necessary, the Pharmacist should be notified a. True b. False Click below to fill in your answer sheet on-line for submission